Influence of self-perceived incontinence severity on quality of life and sexual function in women with urinary incontinence

AIMS: We examined the impact of patient-perceived incontinence severity (PPIS) on health-related quality of life (QoL) and sexual function in women with urinary incontinence (UI). METHODS: Patients were recruited from clinic practices at one hospital. Between May 2004 and June 2006, 353 women 27-79 years old (mean 55.7) underwent detailed evaluations. To obtain health-related QoL and sexual function assessments, the patients were asked to fill the questionnaires including the incontinence quality of life (I-QoL) and female sexual function index (FSFI). Patients were categorized into the three groups according to the PPIS; 'mild,' 'moderate,' and 'severe.' RESULTS: Among groups, the duration of symptoms, rate of mixed UI, mean number of treatment visits over the past year, rate of UI associated without any activity, and Valsalva leak point pressure (VLPP) was significantly different (P < 0.05). The I-QoL total score and subscale scores deteriorated significantly as the PPIS increased (P < 0.001). Of the six domains in the FSFI questionnaire, four domains, namely, 'arousal' (P = 0.026), 'lubrication' (P = 0.012), 'orgasm' (P = 0.017), and 'pain' (P = 0.037) as well as the FSFI total score (P = 0.004) were significantly different among the groups. CONCLUSIONS: Our findings suggest that PPIS significantly influences health-related QoL and sexual function, and that strategies for assessing PPIS should be incorporated for assessing patients with UI.     

Female sexual function before and after treatment of urinary incontinence

The prevalence of urinary incontinence is around 20% of healthy middle-aged women. Incontinence causes a negative impact on the quality of life and sexuality. From August 2002 to January 2004, 30 patients (mean age 43 years) with stress urinary incontinence (59%), overactive bladder (15%) and mixed incontinence (26%) answered the ICIQ-SF(International Consultation on Incontinence Questionnarie-Short Form) and FSFI (Female Sexual Function Index) questionnaires before and after treatment for urinary incontinence. The follow-up ranged from 12 to 53 months. Mean ICIQ score was 17 and 7 before and after treatment respectivelly (p<0,001). Overactive bladder showed the worst scores in all domains. The patients who underwent surgery increased their scores of desire (p=0,02), satisfaction (p=0,05) and total score (p=0,02). Thirteen patients which ICIQ was zero increased: desire (p<0,01), satisfaction (p=0,05) and total score (p=0,01). Urinary incontinence significantly affects the quality of life. Therefore sexual evaluation in incontinence patients is recommended.     

Effect of urinary leakage on sexual function during sexual intercourse

AIM: This study was planned to determine the effect of urinary leakage on sexual function during sexual intercourse. METHODS: The study group included 32 incontinent women who had urinary leakage during sexual intercourse and the control group consisted of 60 women with no such problem. The Sexual History Form of Schover and Jensen was completed in face-to-face interviews in a private room. RESULTS: When compared with the women without any problem, the women with urinary incontinence were 4.7 times less satisfied with their sexual life and their partners had ejaculation without full erection 3.1 times more. In order to cope with the problem of urinary incontinence during coitus the women themselves adopted several methods. Trying to keep their partners unaware of the problem and deferring the intercourse were among the most frequently adopted methods. 43.7% of the study group indicated that this problem affected their sex life. CONCLUSIONS: The results of this study support the view that urinary leakage during coitus affects women's sex life adversely.     

Effect of sacral neuromodulation for faecal incontinence on sexual activity.

INTRODUCTION: Faecal incontinence affects a percentage of the population and can have a significant effect on their ability to establish and maintain sexual relations. PATIENTS AND METHODS: Sixteen consecutive patients with permanent sacral neuromodulation (SNM) for faecal incontinence completed a 'Sex Life Questionnaire' at their follow up visit to ascertain whether there was any improvement in this aspect of their life. RESULTS: Nine of the sixteen patients was sexually active. These nine patients (median age 56 (35-61) years) had a significant reduction in faecal incontinence episodes per week from a median of 12 (1-55) to 1.5 (0-8.5) (P = 0.008). All nine patients reported that their sex life had been affected by feacal incontinence prior to SNM and seven had felt benefit from implantation. The median improvement in their sex life was 40% (1-100) and the percentage improvement was inversely correlated to age (r = -0.834, P = 0.005). CONCLUSION: SNM improves the quality of sexual activity in 78% of patients. More improvement seems to be gained the younger the patients.     

Effect of renal transplantation on sexual function

This investigation was conducted to determine whether renal transplantation can improve sexual function in male patients with chronic renal failure. The authors retrospectively studied 121 men undergoing renal transplantation who complained of any type or degree of sexual dysfunction pre-operatively. Sexual function was evaluated by questionnaire which included erectile, ejaculative, and orgasmic functions. Pre- and postoperative frequency of sexual intercourse was also recorded. Patient characteristics, laboratory data, and endocrinologic profiles were analyzed to identify factors that might influence sexual function. In patients with hormonal determinations, results essentially normalized after transplantation. However, only 43 patients (35.5%) reported improvement of overall sexual function after renal transplantation, while 34 (28.1%) reported worsening. Although frequency of sexual intercourse was unaffected by transplantation, 15 of 20 patients who had no intercourse before transplantation initiated intercourse afterward. These 15 patients all underwent transplantation before 40 years of age. Comparisons of variables by sexual function showed significant differences for type of immunosuppressive treatment, interval after renal transplantation, and serum concentration of hemoglobin A1c. It is concluded that renal transplantation cannot improve sexual function in all patients, although hormonal profiles were largely normalized, and that renal transplantation should be encouraged at a younger age.     

The impact of pelvic organ prolapse on sexual function in women with urinary incontinence

The aim of the study is to evaluate the impact of pelvic organ prolapse (POP) on sexual function in women with urinary incontinence (UI). In this retrospective, case-cohort study, we reviewed the medical records of all women evaluated for UI between March and November 2003. All patients completed the short forms of the Urogenital Distress Inventory, Incontinence Impact Questionnaire, and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire. Women with stage two or greater POP, as determined by the pelvic organ prolapse quantification (POPQ) system, were compared to women with stage 0 or 1 POP. Sixty-nine women with POP and 47 women without POP were included. Patient demographics did not differ between the two groups. Women with POP were significantly more likely to report absence of libido (53% versus 30%, P=0.02), lack of sexual excitement during intercourse (46% versus 27%, P=0.05), and that they rarely experienced orgasm during intercourse (49% versus 30%, P=0.05). In conclusion, women with POP in addition to UI are more likely to report decreased libido, decreased sexual excitement, and difficulty achieving orgasm during intercourse when compared to women with UI alone.     

Change of sexual function after midurethral sling procedure for stress urinary incontinence

Objectives:   To compare sexual function in women before and after the midurethral sling procedure for stress urinary incontinence (SUI).
Methods:   A total of 75 women undergoing surgery for SUI between September 2005 and September 2006 were recruited for this study. Those who completed the Female Sexual Function Index (FSFI) preoperatively and 6 months postoperatively were included in the analysis. The FSFI is a validated, 19-item questionnaire, which assesses six domains of sexual function, including desire, arousal, lubrication, orgasm, satisfaction, and pain.
Results:   Data were analyzed for 47 patients. Overall sexual function after the midurethral sling procedure was not significantly different. There were no significant differences in overall sexual function or any of the individual FSFI domain scores between patients with and without concomitant posterior colporrhaphy. There were no significant differences in sexual function between the transobturator and the retropubic surgical routes.
Conclusions:   There is no significant change in overall sexual function in women undergoing the midurethral sling procedure. Posterior colporrhaphy and operative methods do not affect overall sexual function.     

Pelvic floor muscle training improves sexual function of women with stress urinary incontinence

The aim of this study was to assess the effect of a program of supervised pelvic floor muscle training (PFMT) on sexual function, in a group of women with urodynamically diagnosed stress urinary incontinence (SUI), using a validated questionnaire. Incontinence episodes frequency and continence pads used per week were measured before and after treatment using a 7-day bladder diary. Improvements in sexual function were assessed using the Female Sexual Function Index (FSFI). Seventy women completed the 12-month program of supervised PFMT successfully. At the end of the study, incontinence episode frequency decreased by 38.1%, and patients required 39% less pads per week. All domains of the FSFI were also significantly improved with median total FSFI scores increasing from 20.3 to 26.8. This is one of the few studies to quantify, using a validated questionnaire, the improvement in sexual function of women with SUI, undergoing successfully a 12-month supervised PFMT program.     

Effect of biofeedback and electrostimulation on sphincter function in fecal incontinence

The following study reports on the effect of biofeedback and transanal electric stimulation as a conservative method in the therapy of idiopathic fecal incontinence. 22 consecutive patients in whom the diagnosis "idiopathic incontinence" was established after endoscopy, endoanal ultrasound and measurement of pudendal nerve terminal motor latency underwent combined sphincter training for 3 months. The results were evaluated prospectively by clinical classification using a modified Kelly-Holschneider-score and anal manometry before and after treatment. Combined biofeedback led to a significant increase of the continence score in 18 of 22 patients (7.7 +/- 3.8 vs. 9.3 +/- 3.0, p = 0.004). Both squeeze (77 +/- 28 mmHg vs. 92 +/- 32 mmHg, p = 0.047) and resting pressures (40 +/- 19 vs. 52 +/- 23 mmHg, p = 0.015) increased significantly during the training period. There were no significant differences in squeeze and resting asymmetry indexes, sensory and urge thresholds and maximal tolerable volumes. The prolongation of biofeedback training from 3 to 6 months in 9 patients did not change clinical or manometric results significantly. CONCLUSIONS: The combination of biofeedback training with anal electrostimulation increases anal squeeze and resting pressures, thus leading to an improvement of clinical incontinence symptoms. Therefore it should be the first choice in the therapy of idiopathic fecal incontinence. A training period of 3 months seems to be sufficient.     

Coital incontinence: a factor for deteriorated health-related quality of life and sexual function in women with urodynamic stress urinary incontinence

Introduction and hypothesis

To assess the impact of coital incontinence (CI) on health-related quality of life (HRQoL) and quality of sexual function (QSF) in women with urodynamic stress urinary incontinence (SUI).

Methods

Women were recruited for this cross-sectional study from among 289 patients with lower urinary tract symptoms, underwent clinical and urodynamic evaluation. Of these 289 women, 127 sexually active women with SUI completed the King’s Health Questionnaire (KHQ) and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ), of whom 97 were enrolled for the study. The study group comprised 53 women with CI occurring ‘sometimes’, ‘usually’ or ‘always’, and the control group comprised 44 women without CI. Total and individual domain scores were evaluated.

Results

CI was reported by 65.35 % of the women. The frequency of CI was correlated with lower educational level and higher body mass index (r?=?0.22 and r?=?0.23, respectively; p?=?0.01). The KHQ results showed significantly lower HRQoL in women with CI in all domains (p?<?0.05) apart from Sleep/energy’ (p?=?0.054). PISQ revealed no significant differences in QSF in the Behavioral/emotive and Partner–related domains (34.3?±?10.0 vs. 33.0?±?12.2 and 18.0?±?2.9 vs. 18.2?±?3.6, respectively). Women with CI reported a significantly lower QSF in the Physical domain (29.1?±?6.6 vs. 35.0?±?4.6, p?=?0.001), and the total PISQ score was lower but the difference was not significant (81.4?±?14.3 vs. 86.2?±?16.5). Total PISQ score was correlated with age (r?=??0.28, p?=?0.001). Women with CI were significantly more likely to admit that fear of incontinence or fear of embarrassment restricted their sexual activity (p?<?0.001).

Conclusions

A large percentage (65.35 %) of women with SUI reported CI, which had a negative impact on HRQoL and QSF in the Physical domain, but no significant impact on overall QSF.

     

Effects of laser procedure for female urodynamic stress incontinence on pad weight,urodynamics, and sexual function

Introduction and hypothesis

The impact of the IncontiLase^TM procedure on lower urinary tract symptoms (LUTS) remains unclear. Our aim was to evaluate the effects of the IncontiLase^TM procedure for urodynamic stress incontinence (USI).

Methods

All consecutive women with USI prospectively underwent the IncontiLase^TM procedure. Urodynamic studies, pad testing, LUTS, and sexual function questionnaires were assessed before and after treatment.

Results

Thirty-five women underwent the IncontiLase^TM procedure. Among the 28 women with baseline pad weights >1 g, 11 (39.3 %) were objectively cured and 11 (39.3 %) improved. Among the 18 women with mild USI (i.e., baseline pad weight 1–10 g), nine (50 %) were cured and five (27.8 %) improved. Among ten women with baseline pad weight >10 g, two (20 %) were cured and six (60 %) improved. Among the 32 women with complete questionnaire data at 6 months, seven (21.9 %) were subjectively cured, and four (12.5 %) improved. Regarding LUTS, the majority of domains on the King’s Health Questionnaire and female sexual desire and function exhibited significant improvements. Forty percent (12/30) of the partners of these patients felt their sexual function had improved at 6 months. Nonetheless, urodynamic values did not differ across the timeline.

Conclusions

The effect of the IncontiLase^TM procedure for mild USI was moderate at 6-month follow-up but was not effective for pad weight >10 g. Moreover, it improved LUTS, quality of life, QoL, and sexual function of both partners. Further studies should be performed to assess long-term sustained efficacy.

     

Effect of phenoxybenzamine (dibenzyline) on sexual function in man

Phenoxybenzamine (Dibenzyline) has been extremely effective in treating patients with detrusor dyssynergia. Its minimal side effects include: mouth dryness, nasal congestion, drowsiness and fatigue, nausea and vomiting, palpitations, ejaculatory failure, and retrograde ejaculation. Nineteen men treated with phenoxybenzamine for detrusor dyssynergia reported ejaculatory failure during treatment; normal ejaculation returned after treatment was discontinued. Postmasturbation urine and semen samples were analyzed for sperm and fructose. The results of the study suggest that ejaculatory failure was due to the lack of seminal emission into the posterior urethra, rather than retrograde ejaculation. Some implications of this study are also discussed.     

Effect of diabetes mellitus on female sexual function and risk factors

The study was conducted to investigate the effect of diabetes mellitus upon female sexual function, and to detect possible risk factors that might predict sexual dysfunction. The study consisted of 127 married women: 21 women with type 1 diabetes, 50 women with type 2 diabetes and 56 healthy women as a control. Female sexual functions were evaluated with a questionnaire to assess sexual desire, arousal, lubrication, orgasm, satisfaction and pain. The prevalence of sexual dysfunction was 71% in the type 1 diabetic group, 42% in the type 2 diabetic group and 37% in the control subjects. The scores for sexual desire, arousal and lubrication were significantly lower in the type 1 diabetes group than in the control subjects (p < 0.05). The scores of orgasm, satisfaction, dyspareunia and total sexual function were slightly lower in the type 1 diabetic group than in the other groups. No factor predicted sexual dysfunction in the diabetic women while further age, poor education, absence of occupation and menopause predicted sexual dysfunction in the control subjects. The prevalence of sexual dysfunction was significantly higher in the type 1 diabetic women than in the type 2 diabetics and control subjects. However, no risk factors that might cause sexual dysfunction could be predicted in diabetic women.     

Minimum 2-year follow-up of mid-urethral slings, effect on quality of life, incontinence impact and sexual function

Introduction and hypothesis  

In this study, the impact of mid-urethral slings (MUS) on incontinence-related distress, quality of life and sexual function is assessed at a minimum 2 years.